Fibromyalgia Syndrome


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  • Fibromyalgia is a common musculoskeletal condition. It is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue, as well as other symptoms. Fibromyalgia is a chronic condition that affects about 5 million Americans ranging in age 25-60. Women are 10 times more likely to get this disease than men. Doctors diagnose fibromyalgia based on a patient's symptoms and physical exam. Patients experience pain and stiffness in the muscles, but there are no measurable findings on X-rays or most lab tests. While fibromyalgia does not damage the joints or organs, the constant aches and fatigue can have a significant impact on daily life.  This presentation is a brief overview of fibromyalgia syndrome (FMS) and covers the symptoms, the diagnosis, and both standard and alternative treatments. A syndrome is a set of symptoms. When they exist together, they imply the presence of a specific disease or a greater chance of developing the disease. With fibromyalgia syndrome, the following symptoms commonly occur together:Anxiety or depressionDecreased pain threshold or tender pointsIncapacitating fatigueWidespread pain
  •  The hallmark of fibromyalgia is muscle pain throughout the body, typically accompanied by:FatigueSleep problemsAnxiety or depressionSpecific tender points One of the unique aspects of fibromyalgia is the presence of tender points in specific locations on the body. When these points are pressed, people with fibromyalgia feel pain, while people without the condition only feel pressure.  After pain, the most common and debilitating symptom of fibromyalgia is fatigue. This is not the normal tiredness that follows a busy day, but a lingering feeling of exhaustion. People with fibromyalgia may feel tired first thing in the morning, even after hours spent in bed. The fatigue may be worse on some days than others and can interfere with work, physical activity, and household chores. Many people with fibromyalgia have sleep problems, including trouble falling asleep or frequent awakenings during the night. Studies suggest some patients remain in a shallow state of sleep and never experience restful, deep sleep. This deprives the body of a chance to repair and replenish itself, creating a vicious cycle. Poor sleep may make pain seem worse, and pain can lead to poor sleep. Nearly a third of people with fibromyalgia also have major depression when they are diagnosed. The relationship between the two is unclear. Some researchers believe depression may be a result of the chronic pain and fatigue. Others suggest that abnormalities in brain chemistry may lead to both depression and an unusual sensitivity to pain. Symptoms of depression may include difficulty concentrating, hopelessness, and loss of interest in favorite activities. Some patients with fibromyalgia have pain and achiness around the joints in the neck, shoulder, back, and hips. This makes it difficult for them to sleep or exercise. Other symptoms include:Abdominal painChronic headachesDryness in mouth, nose, and eyesHypersensitivity to cold and/or heatInability to concentrate (called "fibro fog")IncontinenceIrritable bowel syndromeNumbness or tingling in the fingers and feetStiffness
  • There are many theories about the causes of fibromyalgia, but research has yet to pinpoint a clear culprit. Some doctors believe hormonal or chemical imbalances disrupt the way nerves signal pain. Others suggest a traumatic event or chronic stress may increase a person's susceptibility. Most experts agree that fibromyalgia probably results from a combination of factors, rather than a single cause.   The pain of fibromyalgia can be intense. Because traditionally no lab tests or X-rays could confirm a diagnosis of fibromyalgia, some patients were once led to believe this pain was "all in their heads." But the medical community now accepts that the pain of fibromyalgia is real. Research suggests it's caused by a glitch in the way the body perceives pain. Women between the ages of 25 and 60 have the highest risk of developing fibromyalgia. Doctors aren't sure why, but women are 10 times more likely to have the condition than men. Some researchers believe genetics may play a role, but no specific genes have been identified. A doctor may diagnose fibromyalgia after hearing the patient’s symptoms and doing a physical exam. There’s one lab test that can check for fibromyalgia. It measures the levels of proteins in the bloodstream and can help confirm a fibro diagnosis.
  • Constantly fighting pain and fatigue can make people irritable, anxious, and depressed. You may have trouble staying on task at work, taking care of children, or keeping up with household chores. Exercise or hobbies such as gardening may seem daunting. Exhaustion and irritability can also lead to missing out on visits with friends. Fortunately, there are effective treatments that help many patients get back to the activities they enjoy. Fibromyalgia was once the exclusive domain of rheumatologists. Today, the condition has captured the attention of a wide range of health care providers. Many people receive treatment through their primary care providers.  Fibromyalgia TriggersAn important first step is identifying what makes your symptoms worse. Common triggers include:Cold or humid weatherToo much or too little physical activityStressPoor sleep Stress appears to be one of the most common triggers of fibromyalgia flare-ups. While it's impossible to eliminate all stress from your life, you can try to reduce unnecessary stress. Determine which situations make you anxious -- at home and at work -- and find ways to make those situations less stressful. Experiment with yoga, meditation, or other relaxation techniques. And allow yourself to skip nonessential activities that cause stress.  The goal of fibromyalgia treatment is to minimize pain, sleep disturbances, and mood disorders. Doctors may recommend medications that help ease your symptoms -- ranging from familiar over-the-counter pain relievers to prescription drugs. There are also prescription drugs specifically approved for the treatment of fibromyalgia, which include Cymbalta, Lyrica, and Savella. Exercise can relieve several fibromyalgia symptoms. Physical activity can reduce pain and improve fitness. Exercising just three times a week has also been shown to relieve fatigue and depression. But it's important not to overdo it. Walking, stretching, and water aerobics are good forms of exercise to start with for people with fibromyalgia. Some experts say diet may play a role in fibromyalgia -- just not the same role in all patients. Certain foods, including aspartame, MSG, caffeine, and tomatoes, seem to worsen symptoms in some people. But avoiding these foods won't help everyone. To find out what works for you, try eliminating foods one at a time and recording whether your symptoms improve.Some research suggests massage may help relieve fibromyalgia pain, though its value is not fully proven. Practitioners say that applying moderate pressure is key, while the technique is less important. Rubbing, kneading, or stroking all seem to help. A significant other can learn to provide regular massages -- and a 20-minute session may be long enough to get results. Formal studies have produced mixed results on the use of acupuncture for fibromyalgia, but some patients say it eases their symptoms. This traditional Chinese practice involves inserting thin needles at key points on the body. Acupressure stimulates the same pressure points and may be a good alternative for people who want to avoid needles.
  • Many people with fibromyalgia find that their symptoms and quality of life improve substantially as they identify the most effective treatments and make lifestyle changes. While fibromyalgia is a chronic condition, it does not damage the joints, muscles, or internal organs.
  • Risk factors for fibromyalgia include:Your sex. Fibromyalgia is diagnosed more often in women than in men. Female reproductive hormones may play a part in how women experience pain.Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia. Investigators are constantly looking at various explanations for the occurrence of fibromyalgia. Some, for example, are exploring hormonal disturbances and chemical imbalances that affect nerve signaling. Other experts believe fibromyalgia with its deep muscle pain is linked to stress, illness, or trauma. Still others think there is a hereditary cause or say there is no explanation at all. But while there is no clear consensus about what causes fibromyalgia, most researchers believe fibromyalgia results not from a single event but from a combination of many physical and emotional stressors.Other Theories About Causes of FibromyalgiaSome have speculated that lower levels of a brain neurotransmitter called serotonin leads to lowered pain thresholds or an increased sensitivity to pain. It's associated with a calming, anxiety-reducing reaction. The lowered pain thresholds in fibromyalgia patients may be caused by the reduced effectiveness of the body's natural endorphin painkillers and the increased presence of a chemical called "substance P." Substance P amplifies pain signals.There have been some studies that link fibromyalgia to sudden trauma to the brain and spinal cord. Keep in mind, though, theories about what causes fibromyalgia are merely speculative. Who Gets Fibromyalgia?Fibromyalgia is far more common in women than in men. Some interesting studies show that women have approximately seven times less serotonin in the brain. That may explain why fibromyalgia syndrome, or FMS, is more common in women.Another theory states that fibromyalgia is caused by biochemical changes in the body and may be related to hormonal changes or menopause. In addition, some (but not all) people with fibromyalgia have low levels of human growth hormone, which may contribute to the muscle pain. Does Stress Cause Fibromyalgia?Some researchers theorize that stress or poor physical conditioning are factors in the cause of fibromyalgia. Another theory suggests that muscle "microtrauma" (very slight damage) leads to an ongoing cycle of pain and fatigue. This mechanism, like all the others, is still unproven for fibromyalgia. Do Insomnia or Sleep Disorders Cause Fibromyalgia?Most people with fibromyalgia experience insomnia or non-restorative sleep -- sleep that is light and not refreshing. Disordered sleep might lead to lower levels of serotonin, which results in increased pain sensitivity. Researchers have created a lower pain threshold in women by depriving them of sleep, possibly simulating fibromyalgia.Is Depression Linked to Fibromyalgia?Some scientists used to believe that because fibromyalgia was accompanied by low-grade depression, there may be a link between the two illnesses. Today, mental health issues are no longer thought to cause fibromyalgia. However, chronic pain can cause feelings of anxiety and depression, which may worsen fibromyalgia symptoms. Is Fibromyalgia Hereditary?Like other rheumatic diseases, fibromyalgia could be the result of a genetic tendency that's passed from mother to daughter. Some researchers believe that a person's genes may regulate the way his or her body processes painful stimuli. These scientists theorize that people with fibromyalgia may have a gene or genes that cause them to react intensely to stimuli that most people would not perceive as painful. To date, these genes have not been isolated or identified.It's thought that when a person with this genetic tendency is exposed to certain emotional or physical stressors -- such as a traumatic crisis or a serious illness -- there is a change in the body's response to stress. This change can result in a higher sensitivity of the entire body to pain.
  • Fibromyalgia can't be prevented or cured. But treating symptoms may help reduce how long a flare-up lasts. Studies do not agree about the outlook for people with fibromyalgia. For example, results from some specialized treatment centers show a poor outlook. However, community-based treatment programs show that symptoms go away in a quarter of patients and symptoms significantly improve in about half.
  • What Is It?People with fibromyalgia have widespread pain, aches and stiffness in muscles and joints throughout the body along with unusual tiredness. There is no known cause of fibromyalgia. Fibromyalgia affects an estimated 3.4% of women and 0.5% of men in the United States, or 3 million to 6 million Americans. It most commonly affects women of childbearing age or older. Many people with fibromyalgia also have psychiatric problems such as depression and anxiety. DiagnosisAfter asking about symptoms, a doctor will check for swelling, redness and impaired movement in parts of the body where the patient is having pain. A lab test will also be done to determine if the patient has fibromyalgia. Expected DurationThe symptoms of fibromyalgia are usually chronic. While treatment can be helpful, symptoms tend to be long-lasting (and frequently lifelong).PreventionThere is no known way to prevent fibromyalgia.TreatmentPrescription and over the counter medicine can treat fibromyalgia.  In recent years, the FDA has approved Lyrica and Cymbalta for the treatment of fibromyalgia. Non-medication treatments can also be helpful such as regular low impact exercise. Also improved sleep quality may improve symptoms, so it may help to avoid caffeine, exercise late in the day and fluids late in the evening. Therapies such as acupuncture and massage therapy can help to manage the condition. PrognosisStudies do not agree about the outlook for people with fibromyalgia. For example, results from some specialized treatment centers show a poor outlook. However, community-based treatment programs show that symptoms go away in a quarter of patients and symptoms significantly improve in about half. Fibromyalgia is a controversial illness. Some physicians don't believe that it's a medical illness but may be a reflection of psychological distress or stress. However, there's no proof of a psychological cause either. Until we have a better understanding of the disorder, it's likely to remain controversial.
  • Fibromyalgia Syndrome

    1. 1. FIBROMYALGIA SYNDROME Presented By: Class December 23, 2013
    2. 2. OUTLINE • • • • • • • • • • What is Fibromyalgia Symptoms Diagnosing Treatment Options Outcomes of Treatment Risk Factors Prevention Summary Questions References
    3. 3. WHAT IS FIBROMYALGIA? • Common musculoskeletal condition • Consists of of set of symptoms that occur together • Often misdiagnosed and misunderstood • More than 12 million Americans have the condition • Affects more women than men
    4. 4. SYMPTOMS OF FIBROMYALGIA • Muscle pain throughout entire body, including joints • Tender points • Fatigue • Sleep problems • Major depression
    5. 5. DIAGNOSING FIBROMYALGIA • • • • • • Various theories of the cause of fibromyalgia Combination of factors lead to proper diagnosis Hormonal or chemical imbalance Chronic stress Often misdiagnosed (“All in their heads”) Lab test
    6. 6. TREATMENT OF FIBROMYALGIA • Identifying triggers • Minimize pain, sleep disturbances, and mood disorders • Medication ▫ OTC & Prescription • Exercise • Diet • Massage • Acupuncture
    7. 7. OUTCOMES OF TREATMENT • Symptoms never go away but can improve with treatment • Lifestyle changes • Chronic condition • Does not cause damage to joints, muscles, or internal organs
    8. 8. RISK FACTORS • Gender • Family History/Hereditary • Rheumatic Disease • Hormonal disturbances/Chemical Imbalances • Sensitivity to pain • Stress • Sleep disorders • Depression
    9. 9. PREVENTION OF FIBROMYALGIA • No prevention or cure • Treatment can reduce flare-ups
    10. 10. SUMMARY • • • • • • • What is it? Symptoms Diagnosis Expected Durations Prevention Treatment Prognosis
    11. 11. QUESTIONS?
    12. 12. REFERENCES Definition. (2011, January 22). Mayo Clinic. Retrieved December 21, 2013, from Fibromyalgia. (n.d.). Prevention. Retrieved December 21, 2013, from Fibromyalgia Pictures: Symptoms, Pain, Treatments, Diet, Causes. (n.d.). WebMD. Retrieved December 21, 2013, from Fibromyalgia-Prevention. (n.d.). WebMD. Retrieved December 20, 2013, from Fibromyalgia: Possible Causes and Risk Factors. (n.d.). WebMD. Retrieved December 21, 2013, from What Is Fibromyalgia?. (n.d.). WebMD. Retrieved December 21, 2013, from
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